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Overview of clinical symptoms and clinical diagnosis of membranous glomerulonephritis


Membranous glomerulonephritis (membranous glomerulonephritis) is a major clinical manifestation of proteinuria or nephrotic syndrome. Pathologically, the glomerular capillary basement membrane is uniform and thickened, with the characteristics of diffuse upper subcutaneous immune complex deposition, which is not associated with obvious cell proliferation.

In adults with a large number of proteinuria as the main performance, in particular, nephrotic syndrome, we should think of the possibility of membranous glomerulonephritis, and the diagnosis of membranous glomerulonephritis mainly rely on renal biopsy pathology. After diagnosis, the primary or secondary.

Early membranous nephropathy should be distinguished from mild lesions or focal glomerulosclerosis: sometimes it can not be distinguished under light microscope, mainly by electron microscopy.
The exception of membranous nephropathy due to other secondary causes, such as autoimmune diseases such as systemic lupus erythematosus; for ANA, anti ds-DNA antibody, Sm antibody, RNP and serum complement, combined with clinical manifestations; hepatitis B virus associated membranous nephropathy: in addition to the history of hepatitis B and serum immunological markers, mainly rely on in renal tissue of HBsAg immune complex deposition or HBV-DNA can be diagnosed; difficult in 60 years of age or older manifestation of refractory nephrotic syndrome, should be made on imaging examination, to exclude malignant tumor related membranous nephropathy.
The comorbidities such as clinical pulmonary embolism, acute lumbar pain, hematuria, unexplained proteinuria, increased acute renal damage with single or bilateral renal enlargement should be highly suspected of renal vein thrombosis, for imaging, computed tomography (CT), B ultrasound and Doppler ultrasound blood flow, renal vein angiography examination. At present, the most widely used in the clinical application of percutaneous femoral vein puncture selective renal venography, if found vascular filling defects or venous branches can not be diagnosed. If there is only a local contrast agent drainage delay should also be suspected that the site has a small thrombus. Chronic type, especially in the left kidney, sometimes see collateral circulation.

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